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比较胆囊癌管理中机器人与开放手术技术:详细的系统评价和荟萃分析。

Comparing robotic and open surgical techniques in gallbladder cancer management: a detailed systematic review and meta-analysis.

机构信息

Department of Hepato-Biliary-Pancrease II, Affiliated Hospital of North Sichuan Medical College, Nanchong, China.

Department of Hemodialysis, Sixth People's Hospital, Nanchong, Sichuan, China.

出版信息

J Robot Surg. 2024 Mar 5;18(1):111. doi: 10.1007/s11701-024-01851-8.

Abstract

This meta-analysis aims to evaluate the safety and oncological outcomes of robotic surgery compared to open surgery in treating gallbladder cancer (GBC). In October 2023, we performed a literature search across major global databases such as PubMed, Embase, and the Cochrane Library. We employed a Review Manager for parameter comparisons. This study has been registered with PROSPERO under the identifier CRD42023476686. Our final meta-analysis incorporated 5 cohort studies, encompassing a total of 353 patients. Compared to the Open Group (OG), the Robotic Group (RG) had reduced intraoperative blood loss (WMD - 217.72 ml, 95% CI - 371.08 to - 64.35; p = 0.005), shorter hospital stay (WMD - 1.80 days, 95% CI - 2.66 to - 0.95; p < 0.0001), and fewer overall complications (OR 0.31, 95% CI 0.10-0.97; p = 0.04). However, there was no significant difference between the two groups in terms of operation duration, postoperative inpatient days, readmission rate, major complications, 1-year postoperative survival, 2-year postoperative survival, and mortality rates. In our study, we found that for patients with gallbladder cancer, robotic radical cholecystectomy offers certain potential advantages over open radical cholecystectomy. This suggests that robotic radical cholecystectomy might be the optimal choice for treating gallbladder cancer. However, further validation from high-quality randomized clinical trials is required.

摘要

本荟萃分析旨在评估机器人手术与开放手术治疗胆囊癌(GBC)的安全性和肿瘤学结果。2023 年 10 月,我们对包括 PubMed、Embase 和 Cochrane 图书馆在内的全球主要数据库进行了文献检索。我们使用 Review Manager 进行参数比较。本研究已在 PROSPERO 下注册,标识符为 CRD42023476686。我们的最终荟萃分析纳入了 5 项队列研究,共纳入 353 名患者。与开放组(OG)相比,机器人组(RG)术中出血量减少(WMD-217.72ml,95%CI-371.08 至-64.35;p=0.005),住院时间缩短(WMD-1.80 天,95%CI-2.66 至-0.95;p<0.0001),总并发症更少(OR 0.31,95%CI 0.10-0.97;p=0.04)。然而,两组在手术时间、术后住院天数、再入院率、主要并发症、1 年术后生存率、2 年术后生存率和死亡率方面无显著差异。在我们的研究中,我们发现对于胆囊癌患者,机器人根治性胆囊切除术相对于开放根治性胆囊切除术具有一定的潜在优势。这表明机器人根治性胆囊切除术可能是治疗胆囊癌的最佳选择。然而,需要高质量的随机临床试验进一步验证。

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